Provider Demographics
NPI:1679599104
Name:GOLDENBERG & ASSOCIATES
Entity type:Organization
Organization Name:GOLDENBERG & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHABBIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-233-5000
Mailing Address - Street 1:5003 N ILLINOIS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3419
Mailing Address - Country:US
Mailing Address - Phone:618-233-5000
Mailing Address - Fax:618-233-5040
Practice Address - Street 1:5003 N ILLINOIS ST STE 2
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3419
Practice Address - Country:US
Practice Address - Phone:618-233-5000
Practice Address - Fax:618-233-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0008215157OtherBLUE CROSS/BLUE SHIELD
IL0008215157OtherBLUE CROSS/BLUE SHIELD